Abstract

Background: In nursing homes, 75-90% of direct resident care is provided by personal support workers (PSWs). Many PSWs have multiple employers or work more than full-time hours across several facilities to earn a living wage. These precarious work arrangements may contribute to a high risk of burnout. Furthermore, given the transmissibility of COVID-19 and the impact it has had in nursing homes, it is important that we take a closer look at this workforce to consider its structure and workplace arrangements, and how these characteristics directly impact the health of the workforce. We conducted a workforce survey across multiple nursing homes in Ontario, Canada, to better understand the relationship between workplace arrangements and the health and wellbeing of PSWs and other workers who held multiple jobs at the onset and throughout the COVID-19 pandemic.

Methods: We recruited workers (including PSWs, nursing, physicians and allied health) from 27 nursing homes across Ontario, Canada. Survey data was collected between March 2021 - March 2022. The survey captured the following domains: participant workplace arrangements, COVID-19 vaccination status, healthcare use and health status. Descriptive analyses were performed on the individual-level sociodemographic characteristics and health-related variables, such as general and mental health status, and stratified by health profession and multi-job status. We estimated logistic regression models to examine a worker's propensity to hold more than 1 job, and self-reported "good' general health as well as mental health, controlling for individual worker characteristics (e.g., workplace arrangement, health profession, having multiple jobs, sociodemographic status, comorbidities, and access to primary care).

Results: A total of 1,488 workers were included in the study. Among the 406 PSWs included in our analysis, 23% (n=94) held 2+ jobs, with 87% (n=82) of those with 2+ jobs identifying as female. Compared to other workers (physicians, nursing, and allied health), PSWs were 1.4 times more likely to hold 2+ jobs. With respect to immigration status, 69% (n=62) of PSWs who held 2+ jobs were immigrants, whereas 46% (n=81) of other workers who held 2+ jobs identified as immigrants. Finally, while there were no significant differences in self-reported general health status among PSWs by employment status (66% of those with 2+ jobs reported excellent general health vs. 65% of those with 1 job reported excellent general health), PSWs with 2+ jobs reported better mental health status than those PSWs with only 1 job (51% reported excellent mental health vs. only 36% in those with 1 job reported excellent mental health).

Conclusion: Our findings indicate there is a trend among the PSW workforce in holding additional jobs, suggesting it is worth exploring why they do so, how it may impact their practice, as well as their health and wellbeing. Without a focus on workers' health and interventions to support their wellbeing, we can anticipate seeing a continued deterioration in work-life quality and retention of this workforce.

Slides